Claims Liability Examiner

SUMMARY

Investigate, evaluate, negotiate, and settle auto claims. Determine liability and coverage efficiently and accurately. Resolve claims within the company and Department of Insurance compliance standards and timeframes. Responsible for the protection of company assets and customers’ contractual interests. Communicate professionally and with an accurate comprehension of the claims process with all participants involved with the claim.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Empathize and assist those who have been involved in an auto accident.
• Evaluate losses utilizing critical thinking and solid judgment to solve problems, make decisions, and resolve complex issues.
• Conduct prompt, thorough, and fair investigations by obtaining relevant facts to determine coverage, origin, and extent of loss.
• Monitor costs to ensure they are reasonable and customary.
• Keep the insured and others informed about the claim status with timely and accurate written/verbal communications to resolve claims efficiently and effectively.
• Confirm or deny coverage of the claim based on the facts and the policy terms and conditions.
• Negotiate the settlement of claims, based on experience, under varying levels of oversight from supervisor and management, according to authority levels and file complexity. Maintain a diary system for file review and document files to reflect the status of work being performed on the file.
• Document and communicate all claims activities timely and effectively, and in a manner that supports the outcome of the claims file.
• Answer phone calls and respond to emails and voicemails in a timely manner.
• Other duties as assigned.

QUALIFICATIONS

To be successful an individual must have a disciplined approach to all job-related activities. A solid foundation of personal organization, sound decision making, analytical skills, customer service skills, and a clear understanding of team commitment are required. This individual should demonstrate the ability to communicate in a clear manner, possess excellent interpersonal skills and must also demonstrate confidence in their decision-making ability.

• Exercise sound financial judgment and discretion in handling insurance claims.
• Knowledge of automobile claims: coverage evaluation, claims investigation, loss assessment, evaluation, reserves, insurance regulations, negotiation and settlement.
• Knowledge of investigation management including but not limited to taking and using recorded statements, determining coverage and application of coverage to claims, negotiation, and resolution of claims.
• Knowledge of California specific adjusting including California insurance claims regulatory compliance, relevant case law and California claims legal framework.
• Arizona, Texas, Washington, and Oregon claim knowledge a plus.
• Self-directed individual who works well with minimal supervision.
• Must have strong analytical skills necessary to make decisions, resolve issues inherent in handling claims effectively by dealing with situations at various levels of intensity and reach a resolution.
• Must be able to interpret insurance policies and various contracts, perform analytical research, and make sound decisions using good judgment.
• Ability to effectively operate a computer and have working knowledge of MS Office applications.
• Ability to multitask.
• Ability to adapt quickly in a fast-paced environment and strong attention to detail.
• An effective listener with the ability to manage, analyze, and execute directions.
• Excellent verbal and written communication skills and the ability to interact professionally with a diverse group of co-workers, supervisors, managers, internal customers, external customers, vendors, and other insurance professionals.
• A Texas All Claims Insurance License may be required, depending on company forecasts.

Education or Experience

Preferred: 2 or more years of experience in automobile claims handling.

Preferred: College degree.

Required: Able to meet minimum efficiency standards for customary business applications such as Word, Excel, Google Sheets, and Teams.